MEDICARE: KATHRYN SUZANNE HERMANAS ATC, LAT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer	096.004292	IL

General Provider Information

NPI Number	:	1952847972
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN SUZANNE HERMANAS ATC, LAT

Provider Business Mailing Address
First Line	:	12213 S. 69TH COURT
Second Line	:
City	:	PALOS HEIGHTS
State	:	IL
Zip	:	60463-1638
Country	:	US
Telephone Number	:	708-691-7458
Fax Number	:

Provider Business Practice Location Address
First Line	:	12213 S 69TH CT
Second Line	:
City	:	PALOS HEIGHTS
State	:	IL
Zip	:	60463-1638
Country	:	US
Telephone Number	:	708-691-7458
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/13/2017
Last Update Date	:	01/13/2017

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